This speech was delivered by Health Ministe Dr Aaron Motsoaledi.
Deputy President of the Republic Mr. Kgalema Motlanthe
Members of the Inter Ministerial Committee on HIV&Aids and TB (IMC)
Representatives of the UNAIDS
Directors General present today
Senior Government Officials
Ladies and gentlemen
The HCT Intensification launch event marks the beginning of a series of activities that will contribute to the attainment of the goals of getting 1, 3 million Public servants to test and know their status and persuade 5 others amongst their families and friends to test and know their status.
As the single biggest employer in South Africa, with nearly 1.3 million public servants at national and provincial level, there is no doubt that the Public Service has a crucial role to play in mitigating the impact of HIV& Aids and TB as part of its overall focus on the health and well-being of its members and their dependants. It is only through a healthy, dedicated, productive and responsive workforce that we can collectively work towards the attainment of efficient and effective service delivery.
This initiative is a first step to rally all Government departments to integrate HIV counselling and testing (HCT) into their annual operational plans, and report on outputs and outcome indicators for their HCT Programme implementation to Department of Public Service and Administration (DPSA), which in turn will submit collated Government Sector report to South African National AIDS Council (SANAC).
Public Service operational plan was developed in 2010 setting a testing target at 49% of the approximately 1, 3 million Public Service employees (637 000) by 31 March 2011 excluding employees of the State Owned Enterprises and dependents of Public Service employees. To date only 18% of this target has been achieved through the departmental HCT campaigns.
The Key Health trends reported by Government Employees Medical Scheme (GEMS) annually, reflects that claims for HIV& Aids and TB related conditions are among the top ten cost drivers for Medical Claims made annually. GEMS further reported that employees are accessing disease management package at an advanced stage of their HIV infection, usually with low CD4 counts which may have great impact on their chances of responding well to antiretroviral treatment. This problem of late diagnosis for HIV and TB infection is common even for the general public.
The HCT campaign aims to get public servants to test, know their status and access treatment early before the current baseline of CD4 count of 200. The total number of HCT events conducted through GEMS programme in the public sector year to date is 982, of which 12426 employees were screened.
Enrolment into GEMS disease management programme has increased from the 2010 baseline by 65% (from 32,243 in 2009/10 to 53,495 in 2010/11 FY) as measured by Aid for Aids (AFA) registration data (GEMS’2010). This is an encouraging milestone; however this enrolment does not occur early enough in the course of the HIV disease progression, before the CD4 count drops below 350. The findings shows that 34% of beneficiaries are enrolled at the CD4 of <200 and a further 22% at a moderately severe immune-suppression. Majority (76%) of AFA registered beneficiaries is principal members (GEMS, 2010).
The proportion of employees tested for HIV through private health care service providers in the last year increased by 78%, from 9791 in April 2010 to 86 324 in June 2011.
Health Risk Management reports for December 2011 submitted to DPSA by four Health Risk Management Companies (Metropolitan Health Risk management, SOMA Initiative, Proactive Health Solutions, and Thandile Health Risk management) reflects high numbers of applications relating to respiratory conditions which do justify suspicion of TB related illnesses for Ill Health Retirement. In all the national and provincial reports reviewed there are three leading conditions, namely:
Psychiatric illnesses (Depression and Anxiety),
Respiratory illnesses and
Muscular-skeletal illness (lower back, osteoarthritis and various orthopedic conditions).
It is a cause for concern that the applications came mostly from the low-level manual workers, except in E.Cape and W.Cape where salary levels 8 & 9 and levels 7 &12 were reported for Long Period Temporary Incapacity Leave respectively. Applications are consistent with the demographic profile of those most vulnerable to HIV& Aids.
Educators comprised the highest category of applicants for various forms of incapacity leaves, followed by general workers and nurses. Several research studies have been undertaken to assess HIV prevalence among educators and among health care workers in South Africa. In these studies the prevalence rate was found to range between 11% and 15, 7% for educators and HCW respectively. In two separate studies for educators and health workers, common social determinants for HIV prevalence were found, namely:
Younger age-groups (18-35year) had higher prevalence than in older age-groups.
Lower income and non-professionals had higher prevalence rate than in higher income and professional groups.
The prevalence was even higher in younger age group for females (25-35 years) than in males (36-49).
In the HCW study conducted in 2007, which also examined the CD4 counts of HIV infected HCW, Nurses were found to be particularly mostly affected with prevalence 13, 9% against the overall prevalence of 11, 5% total population studied. 47% of the sample had the CD4 count below 350, and 19% had CD4 counts actually less than 200.
The above findings demand that the Public Service should aggressively popularise regular HIV counselling and testing, to increase the number of employees who know their HIV status so that they can access treatment care and support very early in the stage of their HIV infection to ensure favourable treatment-outcomes. The HCT campaign should be linked to empowerment of the vulnerable groups, like women, youth, low-income and non-professional groups, in line with the Southern African Development Community (SADC) initiative on Mainstreaming of HIV& Aids into Social and Health issues.
The HCT campaign should also be intensified for employees in the Department of Health (DOH) and Department of Basic Education (DBE), where HIV prevalence has been confirmed to be higher.
The other department whose prevalence has been scientifically established is that of Correctional Services (DCS), for both offenders and employees. In the prevalence study conducted by Limúvune Consulting on South African Prisons, Muntingh reported that: of a total of 1098 staff members who participated in the survey, 109 individuals (9.9%), tested HIV-positive.
Based on these results the report concludes that the national HIV infection rate amongst DCS staff is between 6.7% and 13.9%. Of those who tested positive, 94% were production-level staff, with the balance being from middle management and top management. Their age distribution shows that less than 1% is aged 18-25 years, 45% aged 26-35 years, 42.2% aged 36-45 years, 9.2% aged 46-55 years and 0 above the age of 56 years.
Higher knowledge score on HIV, awareness of a place nearby where one could test for HIV, and impact of HIV on one’s household was found to be associated with Knowing one‘s HIV status. These determinants indicate the need for targeted prevention and BCC messages that need to be inherent in the HCT Intensification campaign.
SANAC prescribed that HCT should form part of the workplace programmes, and that time and space for employees to be tested should be provided. The HCT intensification in the Public Service will provide Government with the opportunity to reinforce its commitment to the SANAC on the National Strategic Plan for HIV& Aids, STI and TB 2012/16 (NSP) and to demonstrate this commitment in practical terms by aggressively intensifying the HCT Campaign and using HCT as a catalyst to the Mainstreaming of HIV& Aids in Cross Cutting issues.
Earlier HIV and TB Screening will ensure early access to HIV& Aids and TB disease management and support for those testing positive. The campaign will further be used to promote healthy lifestyles, increase risk perception and behavioural change in order to reduce risk of contracting these infections. The three guidelines launched today will serve as entry points towards HIV&Aids mainstreaming into Public Service and Administration. It is an honour to launch these guidelines for implementation in the Public Service with effect from 1 April 2013. They are the:
Guidelines on Gender Sensitive, Rights Based, HIV& Aids Mainstreaming Guidelines into Public Service and Administration.
The Guidelines on management of Psychosocial Stressors in the Public Service (The SOLVE Guidelines).
The Guidelines on Child care Facilities in the Public Service.
It is also envisaged that the intensification of the HCT in the Public Service will attain the following results:
Increased number of government departments that are implementing the HCT campaign to increase HCT coverage in the Public Service from 8% (100 056) to 100% (1,3 million) of employeesby 31 March 2016.
Increased number of employees who know their HIV status, through reduction of the stigma and discrimination associated with HIV testing.
Increased implementation of all prescribed HCT screening components, and not just HIV testing.
Intensified development of targeted prevention messages and behavioral change communications (BCC) and interventions which are sector specific, to promote healthy-lifestyle choices irrespective of one’s HIV status.
Increased proportion of HIV infected employees who are enrolled into disease management programme, early in their course of HIV infection before CD4 count drops below 350 cell/ml, to enable them to live longer healthy productive work-lives.
Increased government departments and service provider’s capacity to report on all HCT data in line with the Government Sector M&E Plan and all related tools.
Accurate monitoring of condoms (males and females) distributed in the Government Sector departments.
As we mainstream HIV& Aids into Public Service and Administration and our development, I believe that we can best do so guided by the values of Public Service as described in the constitution. If we do so we will take the Public Service to greater heights of productivity.